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CERTIFICATE OF LIABILITY <br />! <br />°oziarzn <br />INSURANCE <br />4 <br />THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE .AFFORDED BY THE POLICIES <br />BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SI, AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER <br />IMPORTANT: If (he certificate holder Is an ADDITIONAL INSURED, the policy(led) must be endorsed, If SUBROGATION IS WAIVED, subject to the <br />terms and Conditions of the policy, Certain policies may require an endorsement, A statement on this Certificate does not Confer rights t0 the <br />Candidate holder in lieu of such endomoment(si. <br />PRDNUCER VONNIF_.WIGGINSINSURANCEAGENCY <br />11757 BEACH BLVD STE 7 <br />Stateicrar JACKSONVILLE, FL 32246 <br />NAME: BRTTANYFnaRRiS. <br />PNONN Ertr 804 84r DD90 w AI I: @1 41 QQgg <br />nA e$A; BRITTANY .MORRFS.UIEY(o7.3TATEFARM,COM <br />__„ INSURaat6l AFFORe)Ne COVENAOE AAI6a <br />. <br />_ , <br />INSURER A: State Farm Flgnda lnsuranoo CORIDaA . � IQT9 <br />INSURED ELM, INC. ^.INAURERa'..,,~ <br />INSURER <br />1035 KING$ AVE <br />__- <br />INSuReRO. <br />JACKSONVILLE FL 32207 -8311 <br />INSURER E: <br />CLAIMR,MAOE ] OCCUR <br />COVERAGES CERTIFIGA TE NIIMBER� oFt9QrnM%UMBER <br />THIS t$ TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE POR THE POLICY PERIOD <br />INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH. THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN.MAYHAVE BEEN REDUCEOBY PAID CLAIMS. <br />INSR _ - �`�''`r''P LICCYY __ F OG'b YEXF ­ - __._._�. <br />TR TYPE OF INSURANCE POLICYNUMR.P 1 M Ionryyyy 1 1111. - LIMIT$ <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />GENERALUARILITY <br />Y <br />AUTHORIZED RCPAE$ENTATTVE' <br />98-R44632-3 8 <br />40F2012013 t0i=2014 EACH.00CURRENCE <br />{ 1,00a,000 <br />!� COMMERCIAL GENERAL LIABILITY <br />PRP <br />CLAIMR,MAOE ] OCCUR <br />_ .. <br />_ <br />JtEo E %P (AnY aepefscn4 <br />8 <br />S <br />PERSONAL a ARV !NARY <br />3 2,000'"0 <br />GENERAL AGGREGATE <br />0EN'LAGGREOATF LIMIT APPLIES PER'. <br />! <br />PRODUCT'S COMPIOPAGO <br />$ <br />POLICY PRE. LOG <br />I F <br />AUTOMOBILEWARILITY <br />�I <br />- <br />M NnOS .LIMIT <br />t8aKeent <br />ANY AUTO <br />WOILYnUURVIPwpVreonl <br />t <br />A41 OA41EIS SCHEDULED <br />I <br />• ^.- -' ---- -. <br />- ._ <br />!!l��� AUFOS -., ntITOS <br />I <br />I <br />BODILY W,ILRYiPwar3aenp <br />t <br />HIRED M1UT49 <br />NON{W.NF.O.._.... <br />PrOerrd <br />AOWS <br />ICAnIAat..— <br />.. _.. <br />$ <br />UMeRELi.A LIAFl I OCCUR <br />aCCSS UAa - AMS.MAOE <br />I <br />( <br />EACH CCCURRENCP <br />S _ <br />g <br />AGGREGATE <br />RETENTOVa 1X <br />-' <br />- <br />s <br />WORKERS COMPENSATION <br />I <br />tnC gTAT!`i' —OtH <br />' <br />AND EMPLOYERS LIABILITY YIN <br />m i$flSLIMIT$) 1 <br />_ <br />ANYPROPRIBTDRINARTNER�CUT'IVE <br />OFFICEIMEMRER"CUIDED <br />NIA! ❑. <br />@LEACH ACCIOCNT <br />F.,_ <br />F , <br />(Ilyert, <br />(MmWat ry In AN) <br />pn nCa tl t <br />E,L. DISEASE EA EMPLOY <br />5 <br />t <br />P <br />DL,OWFASC, POLICY LIMIT <br />I` <br />ACi9CWPRON OPOPERAIitHyefIORATIONS '(VEHICLES (AVVh ACO40 tat, ACdawnRema,ka.Sthodolo, it vim op;IaeisMq,EPq <br />CERTIFICATE HOLDER ,way V rvA INCEL ATION <br />V 111118- 201QAACORD CORPORATION. AO rights reserved. <br />ACORD 2.F (2010106) The ACORD name and 1090 are registered marks. of ACORD 1001486 732849.8 01.23 -20.13 <br />City of Santa Ana TkT <br />SHOULD ANY OF THE ABOVE DE$CRIOED POLIC188 BE CANCELLED BEFORE <br />A,3$iSYtt <br />29 Civic Center Plata, M36 <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92701 <br />AUTHORIZED RCPAE$ENTATTVE' <br />� t U <br />V 111118- 201QAACORD CORPORATION. AO rights reserved. <br />ACORD 2.F (2010106) The ACORD name and 1090 are registered marks. of ACORD 1001486 732849.8 01.23 -20.13 <br />